title: Prevalence of malignancy in patients with pure main duct intraductal papillary mucinous neoplasms.
abstract: BACKGROUND
  Risk of malignancy in main duct intraductal papillary mucinous neoplasm (MD-IPMN) ranges from 36% to 100% in the literature. Although surgical resection is recommended for all MD-IPMNs, the risk of malignancy based on main pancreatic duct (MPD) size alone remains unclear.
  
  
  OBJECTIVE
  To assess the prevalence of malignancy in symptomatic and asymptomatic patients with pure MD-IPMN based on MPD size.
  
  
  METHODS
  Single-center retrospective study of prospectively collected data.
  
  
  METHODS
  Tertiary referral center.
  
  
  METHODS
  Fifty-two patients with pure low-risk MD-IPMN. Clinical, endoscopic, radiographic, and pathologic data were reviewed.
  
  
  METHODS
  Prevalence of malignancy in patients with pure MD-IPMN based on histopathology of resected lesions.
  
  
  RESULTS
  Sixteen asymptomatic patients had pure MD-IPMN on surgical pathology, 4 (25%) with malignant disease, compared with 25 of 36 symptomatic patients (69%) with pure MD-IPMN. Logistic regression identified symptoms and MPD size as predictors of malignancy. Receiver operating characteristic curve analysis demonstrated that MPD size (optimal cutoff of 8 mm) produced the greatest area under the curve to discriminate between benign and malignant MD-IPMN (.83; 95% CI, .72-.94). MPD size greater than 8 mm has a relative risk of 2.8 for malignancy (95% CI, 1.6-4.9).
  
  
  CONCLUSIONS
  Retrospective, single-center study at a tertiary referral hospital. Study population included only patients who underwent surgical resection.
  
  
  CONCLUSIONS
  Asymptomatic MD-IPMN patients with a duct size of no more than 8 mm have a lower prevalence of malignancy and may represent a distinct group of patients with less aggressive biologic behavior. Further studies are needed to confirm our observations.
authors.affiliation: Department of Internal Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA.
authors.forename: Khaled
authors.initials: K
authors.lastname: Abdeljawad
authors.affiliation: Department of Internal Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA; Division of Gastroenterology, Indiana University School of Medicine, Indianapolis, Indiana, USA.
authors.forename: Krishna C
authors.initials: KC
authors.lastname: Vemulapalli
authors.affiliation: Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana, USA.
authors.forename: C Max
authors.initials: CM
authors.lastname: Schmidt
authors.affiliation: Department of Internal Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA; Division of Gastroenterology, Indiana University School of Medicine, Indianapolis, Indiana, USA.
authors.forename: John
authors.initials: J
authors.lastname: Dewitt
authors.affiliation: Department of Internal Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA; Division of Gastroenterology, Indiana University School of Medicine, Indianapolis, Indiana, USA.
authors.forename: Stuart
authors.initials: S
authors.lastname: Sherman
authors.affiliation: Department of Internal Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA; Division of Gastroenterology, Indiana University School of Medicine, Indianapolis, Indiana, USA.
authors.forename: Thomas F
authors.initials: TF
authors.lastname: Imperiale
authors.affiliation: Department of Internal Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA; Division of Gastroenterology, Indiana University School of Medicine, Indianapolis, Indiana, USA.
authors.forename: Mohammad
authors.initials: M
authors.lastname: Al-Haddad
mesh_terms: D002288:Adenocarcinoma, Mucinous / Q000473:pathology*; D000368:Aged; D002291:Carcinoma, Papillary / Q000473:pathology*; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D010183:Pancreatic Ducts; D010190:Pancreatic Neoplasms / Q000473:pathology*; D015995:Prevalence; D012189:Retrospective Studies; D018570:Risk Assessment